What is Hepaticojejunostomy anastomotic stricture?
Introduction. Benign anastomotic stricture after hepaticojejunostomy (HJ) is one of the serious complications of biliary surgery, which often presents with management difficulties. If left untreated, jaundice, cholangitis, or cirrhosis may develop.
What are the symptoms of bile duct problems?
Symptoms
- Abdominal pain in the upper right side.
- Dark urine.
- Fever.
- Itching.
- Jaundice (yellow skin color)
- Nausea and vomiting.
- Pale-colored stools.
What can cause biliary stricture?
A bile duct stricture is often caused by injury to the bile ducts during surgery. For example, it may occur after surgery to remove the gallbladder. Other causes of this condition include: Cancer of the bile duct, liver or pancreas.
Does a narrow bile duct cause pain?
The symptoms of a stricture depend on its location. If it is in the bile duct, a child’s skin and eyes may yellow (a condition called jaundice), and he or she may experience pain on the upper-right side of the abdomen.
What is Hepaticojejunostomy procedure?
A hepaticojejunostomy is the surgical creation of a communication between the hepatic duct and the jejunum; a choledochojejunostomy is the surgical creation of a communication between the common bile duct (CBD) and the jejunum.
When is Hepaticojejunostomy done?
Why is a hepaticojejunostomy performed? Normally, the hepatic duct joins the cystic duct (the duct that carries bile from the gallbladder) to form the common bile duct that drains the bile into the duodenum. When disease or injury in the biliary system obstructs the free flow of bile, digestion is impaired.
What does biliary pain feel like?
Symptoms. A person with biliary colic typically feels pain in the middle to right upper abdomen. The pain can feel sharp, crampy, or like a constant dull ache. Colic often occurs in the evening, especially after eating a heavy meal.
How do you treat a bile duct stricture?
Treatment options for bile duct strictures include endoscopic or percutaneous balloon dilatation and insertion of an endoprosthesis or surgery. Decompression of the biliary system is usually performed endoscopically, with placement of a nasobiliary tube or one or two 10Fâ12F stents after sphincterotomy.
How is bile duct stricture diagnosed?
How is biliary stricture diagnosed?
- Ultrasound of the liver is the imaging test that is usually ordered first, as it is easy and safe to perform.
- CT scan and MRI scan are capable of showing small strictures and possibly finding out what is causing the stricture.
What percentage of biliary strictures are malignant?
It can be the result of either benign or malignant pathologies, but unfortunately, the majority of biliary strictures are malignant (76â85%) at the time of diagnosis [1].
How long can you live with a blocked bile duct?
Death from obstructive jaundice in the first few weeks of its course is quite rare and is only occasionally observed. After a period varying from four to six months, however, patients suffering from occlusion of the common bile duct usually deteriorate rapidly and die.
Why Hepaticojejunostomy is done?
Hepaticojejunostomy is constructed with the hope of providing adequate drainage to the biliary tract for unimpeded passage of newly formed intrahepatic stones. Intrahepatic strictures proximal to the hepaticojejunal anastomosis impede free drainage of bile and passage of stones.
How is hepaticojejunostomy stricture (HJ) treated?
Proposed management of patients with hepaticojejunostomy strictures. In patients with isolated HJ strictures, first-line treatment should be as much conservative as possible. Surgery should remain a second-line treatment after failure of well-conducted conservative management or in rare cases of associated Roux-en-Y malfunction Table 23.2
What is the prevalence of hepaticojejunostomy?
In total, 3,374 patients underwent an operation requiring either a hepaticojejunostomy (54.33%; N=1,833) or choledochojejunostomy (45.67%; N=1,541). The mean age at the time of surgery was 75.3±6.2 years; 2,070 (61.3%) patients had a malignant diagnosis. After surgery, 403 patients (12%) developed a stricture.
What are the long-term results of the Hepaticojejunostomy?
Completion of the hepaticojejunostomy. We strongly believe that the key-points to the long-lasting results of this technique are the prevention of ischemia, the avoidance of bile leak, and the mucosa-to-mucosa anastomosis.
What happens if Hj stricture is not treated?
Untreated HJ stricture could lead to long-term complications such as choledocholithisis, cholangitis, liver abscess formation, secondary biliary cirrhosis, and portal hypertension [6]. Although revision HJ is required in about 20â25% of patients [7], the majority of such strictures can be treated by dilation via transhepatic or jejunal routes [8].